The Authors Respond

Abstract

We thank Dr Kawada for his interest in our study. Three issues were raised. First, with regard to the cutoffs for sleep-wake sensitivity, we followed the protocol of previously published research in patients with traumatic brain injury (TBI) on actigraphic data collection and analysis 1 Sinclair K. Ponsford J. Rajaratnam S.M. Actigraphic assessment of sleep disturbances following traumatic brain injury. Behav Sleep Med. 2014; 12: 13-27 Crossref PubMed Scopus (40) Google Scholar rather than a study on a non-TBI sample. We agree that a future evaluation of cutoff values for sleep sensitivity in patients with TBI would be of interest. Second, the focus of our study was to identify sleep difficulties in people with severe TBI undergoing rehabilitation (and the potential impact this may have on rehabilitation and outcome). We did not aim to investigate whether sleep difficulties were more common than in the general population; hence, a control group was not required. Our design was in this way in keeping with other studies on sleep difficulties in patients with TBI. 2 Worthington A.D. Melia Y. Rehabilitation is compromised by arousal and sleep disorders: results of a survey of rehabilitation centres. Brain Inj. 2006; 20: 327-332 Crossref PubMed Scopus (60) Google Scholar , 3 Makley M.J. English J.B. Drubach D.A. Kreuz A.J. Celnik P.A. Tarwater P.M. Prevalence of sleep disturbance in closed head injury patients in a rehabilitation unit. Neurorehabil Neural Repair. 2008; 22: 341-347 Crossref PubMed Scopus (95) Google Scholar , 4 Nakase-Richardson R. Sherer M. Barnett S.D. et al. Prospective evaluation of the nature, course, and impact of acute sleep abnormality after traumatic brain injury. Arch Phys Med Rehabil. 2013; 94: 875-882 Abstract Full Text Full Text PDF PubMed Scopus (66) Google Scholar Finally, we cited the case series by Zollman et al 5 Zollman F.S. Cyborski C. Duraski S.A. Actigraphy for assessment of sleep in traumatic brain injury: case series, review of the literature and proposed criteria for use. Brain Inj. 2010; 24: 748-754 Crossref PubMed Scopus (42) Google Scholar to acknowledge the recommendations in the article that actigraphy can be used in patients with severe TBI, albeit taking care not to invalidate because of motor, cognitive, or behavioral impairment. Sleep Problems in Patients With Traumatic Brain Injury by ActigraphyArchives of Physical Medicine and RehabilitationVol. 96Issue 9PreviewI read with great interest the article by Gardani et al.1 The authors conducted a cross-sectional study to explore the presence and types of sleep disorders in 30 chronic patients with severe traumatic brain injury (TBI) undergoing inpatient rehabilitation. Actigraphy using Actiwatch (Actiwatch 4; CamNtech) was used to monitor sleep for 7 consecutive days in combination with self-reported measures on sleep, mood, fatigue, pain, and daytime sleepiness. The authors recognized that 20 participants (67%) had sleep problems, which were associated with anxiety, fatigue, and daytime sleepiness. Full-Text PDF